Pediatrics Hematology
What is the definition of anemia in pediatrics? - Same as adults, reduction of RBCs or Hb conc below
range BUT ranges vary depending on child's age. they have lower conc physiologically
What are the 4 causes of anemia in children? - 1. Inadequate RBC/Hb production
2.Hemolytic anemia 2/2 RBC abnormality
3.Hemolytic anemia 2/2 intrinsic abnormalities and external factors
4. BLEEDING
Child c/o of constant stomach pain has routine labs drWN. His Hb returns as 11. What are you
suspecting? - This Hb is NORMAL in children, their usual range is 11-12
3 month old funny looking kid (small for age, facial deformity, and deformed upper extremities) presents
to office with symptoms of anemia. Based on inspection, what form of anemia is likely? What do you
expect of the labs? - Common presentation for Black Fan Diamond Syndrome (congenital Hypoplastic
anemia)
Hypoplastic anemias will have normal values EXCEPT for low retics and erythroid elements (RBC
precursors)
4 yo funny lookin kid with hx of type 1 DM and muscle/neuro impairments presents with symptoms of
anemia. what anemia do you suspect? - Pearson Marrow-Pancreas syndrome
Failure to thrive, pancreatic fibrosis, insulin dependent DM, and muscle/nerve impairment. These
children typically have early death due to mitochondrial DNA deletions.
2 yo Patient presents with fatigue, confusion, and pallor. Mother reported he had a serious viral illness
last month. CBC returns with a Hb of 5! What are you suspecting? Whats the PROGNOSIS? - Transient
Erythroblastopenia of Childhood 2/2 viral suppression of bone marrow. This is the most common red
cell aplastia seen in childhood, its transient and will correct in a month or two.
,5 yo Patient presents with lightheadedness and pallor. Mother reported he had a fever with red rash on
his cheeks last month. CBC returns with a low RBC count! You suspect... - Parvovirus induced Hemolytic
crisis
Virus will attack only red blood cells, causes erythropenia.
What complication is a main concern for children with Parvovirus? - Can cause a transient aplastic
anemia, very severe, virus has an increased affinity for RBCs.
Patient recovering from a viral infection has their CBC results return. They show anemia, neutropenia,
and thrombocytopenia. What kind of anemia is this? - Aplastic Anemia, not common in children, will
typically only see if transient after a viral infection, bone marrow tumor, or inherited genetic defect.
What is the most common CONGENITAL aplastic anemia? - Fanconi Anemia, autosomal recessive
transmission
10 yo presents with constant fatigue and ringing in his ears. Physical exam shows Cafe Au lait spots on
torso, as well as abnormalities in the patients radial forearm and thumb. Nuero exam shows
hyperreflexia and the patient has a hx of microcephaly. What ANEMIA are you suspecting? - These are
all signs of Fanconi Anemia, a congenital aplastic anemia
Patient from South America is visiting the states, mother claims he was fighting a bacterial infection and
given an ABx to treat. The child is now pallorous and lethargic. CBC results show Hb=5. What ABx causes
this? - Grey Baby Syndrome (acquired aplastic anemia) 2/2 Chloramphenicol use. This ABx isnt used in
children due to destruction of stem cells.
12 yo Patient w/ hx of tonic-clonic seizures presents with fatigue, pallor, and lethargy. CBC results show
Hb=5. What is likely the cause? - Anti-epileptic medications can cause BM suppression, acquired aplastic
anemia
, What therapy is a predictable cause of acquired aplastic anemia in children - Chemotherapy, goal is to
destroy cells.
What are common viruses that can results in aplastic anemia? - PARVOVIRUS
CMV
Epstein Barr
Hep B+C
HIV
What are causes of normocytic anemia with normal red cell precursors? - 1. Chronic Infection/
inflammation (cancer included)
2. Post-operative inflammation
Dialysis patient w/ chronic renal disease Presents with weakness, pallor, and lightheadedness. What
type of anemia is typically seen with this hx? - Anemia of chronic inflammation/disease (normocytic w/
normal precursors) The bone marrow is normal
What are common causes of chronic anemia of inflammation? - Chronic Renal Disease
SBE
TB
Juvenile Rheum Arthritis
Sarcoidosis
Cancer
what is the common causes of Macrocytic (megaloblastic) anemias in pediatrics? - Folic Acid deficiency
(M/C) + B12 deficiency (less common)
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